"The dual burden of chronic physical conditions and mood and anxiety disorders is a significant and growing problem,” said Silvia Martins, MD, PhD, associate professor of Epidemiology at the Mailman School of Public Health, and senior author.

The research examined survey data to analyze associations between DSM-IV-diagnosed mood and anxiety disorders and self-reported chronic physical conditions among 5,037 adults in São Paulo, Brazil. Participants were also interviewed in person.

Among individuals with a mood disorder, chronic pain was the most common, reported by 50 percent, followed by respiratory diseases at 33 percent, cardiovascular disease at 10 percent, arthritis reported by 9 percent, and diabetes by 7 percent. Anxiety disorders were also common for those with chronic pain disorder at 45 percent, and respiratory at 30 percent, as well as arthritis and cardiovascular disease, each 11 percent. Individuals with two or more chronic diseases had increased odds of a mood or anxiety disorder. Hypertension was associated with both disorders at 23 percent.

"These results shed new light on the public health impact of the dual burden of physical and mental illness,” said Dr. Martins. “Chronic disease coupled with a psychiatric disorder is a pressing issue that health providers should consider when designing preventive interventions and treatment services—especially the heavy mental health burden experienced by those with two or more chronic diseases.”

The study was supported by the São Paulo Research Foundation, Brazil (Grants 2003/00204-3 and 2011/50517-4). Funding was also provided by Fundação de Amparo à Pesquisa do Estado de São Paulo (Grant 14/05363-7). The SPMH Survey is carried out in conjunction with the World Health Organization World Mental Health Survey Initiative.